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Show <fj 1'186 Raven Press. New York Editorial Comment The Paredrine Test and Horner's Syndrome Two papt"rs in this issut" of tilt" Journal address the diagl1l)sis of Horner's syndrome of oculosympathetic part'sis. One points out that the dilatation lag can be dett"ctt"d by careful measurement of the pupil c~'cle times. The other addresses the response of the normal pupil to dilatation with 1% Paredrine. That the dilatation of blue eyes to Paredrine is better than dilatation of brown eyes is, of course, to be expected. An interesting point is that while the tested pupil dilated the control eye constricted, and that is nicely documented by photographs. From the standpoint of the clinician, however, since Paredrine does not detect first and second neuron lesions in the oculosympathetic pathway, but is considered as showing a positive test only in third neuron lesions, my experience has been that the cocaine test is much preferred in practice. In other words, in a patient with a subtle difference in palpebral fissures and with a subtle difference in pupil size, instillation of exactly 1 or 2 drops of 109< cocaine in both eyes will show in about 20 minutes dilatation of the normal pupil as 235 compared to the definite defect or lag of dilatation in the pupil on the side of the oculosympathetic paresis. It is helpful to take photographs before and after this test for a permanent record. Paredrine is a weak mydriatic, however, just as cocaine is, so one must be careful not to overcall poor dilatation of the pupils in a darkly pigmented iris on both sides. To specify the lesion as a third neuron Horner's, however, after initially making the diagnosis with a cocaine test is at times helpful, but one must have the patient return after the effect of all the drops of the first test have worn off. Clinical investigations, however, warrant consideration in the Jot/mal of Clinical Net/fo-ophthalmology, for although this journal is aimed strictly at the practitioner interested in diseases of the eye and nervous system, studies that are practical and related to the patients we see certainly warrant our consideration. We are thankful for both of these papers! J. Lawton Smith, M.D. |
